Healthcare Provider Details

I. General information

NPI: 1912123787
Provider Name (Legal Business Name): GENEVIEVE FOSTER-FREEDMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SOUTHPOINT BLVD
PETALUMA CA
94954-6858
US

IV. Provider business mailing address

39 MEADOWGLEN DR
PETALUMA CA
94952-5222
US

V. Phone/Fax

Practice location:
  • Phone: 707-559-7582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP8413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: